Provider Demographics
NPI:1821135351
Name:AMERYUN, STEPHAN AHMAD (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHAN
Middle Name:AHMAD
Last Name:AMERYUN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NW 72ND ST
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118-1820
Mailing Address - Country:US
Mailing Address - Phone:816-436-5405
Mailing Address - Fax:
Practice Address - Street 1:200 NW 72ND ST
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-1820
Practice Address - Country:US
Practice Address - Phone:816-436-5405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0155681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice